<div id="editReportInfoBackCityModel" class="modal fade" tabindex="-1" role="dialog" aria-labelledby="exampleModalLabel"
  aria-hidden="true">
  <div class="modal-dialog modal-lg">
    <div class="modal-content">
      <div class="modal-body">
        <h3 class="m-t-none m-b "><span><vc:i18n name="修改上报" namespace="editReportInfoBackCity"></vc:i18n></span></h3>
        <div class="ibox-content">
          <div>
            <div>
              <div class="form-group row">
                <label class="col-sm-2 col-form-label"><span><vc:i18n name="姓名" namespace="editReportInfoBackCity"></vc:i18n></span></label>
                <div class="col-sm-10">
                  <input v-model="editReportInfoBackCityInfo.name" type="text" :placeholder="vc.i18n('必填，请填写姓名','editReportInfoBackCity')"
                    class="form-control">
                </div>
              </div>
              <div class="form-group row">
                <label class="col-sm-2 col-form-label"><span><vc:i18n name="身份证" namespace="editReportInfoBackCity"></vc:i18n></span></label>
                <div class="col-sm-10">
                  <input v-model="editReportInfoBackCityInfo.idCard" type="text" :placeholder="vc.i18n('必填，请填写身份证','editReportInfoBackCity')"
                    class="form-control">
                </div>
              </div>
              <div class="form-group row">
                <label class="col-sm-2 col-form-label"><span><vc:i18n name="手机号" namespace="editReportInfoBackCity"></vc:i18n></span></label>
                <div class="col-sm-10">
                  <input v-model="editReportInfoBackCityInfo.tel" type="text" :placeholder="vc.i18n('必填，请填写手机号','editReportInfoBackCity')"
                    class="form-control">
                </div>
              </div>
              <div class="form-group row">
                <label class="col-sm-2 col-form-label"><span><vc:i18n name="来源地" namespace="editReportInfoBackCity"></vc:i18n></span></label>
                <div class="col-sm-10">
                  <select class="custom-select" v-model="editReportInfoBackCityInfo.source">
                    <option selected disabled value="">{{vc.i18n('必填','editReportInfoBackCity')}}，请选择来源地</option>
                    <option value="1001">{{vc.i18n('国内','editReportInfoBackCity')}}</option>
                    <option value="2002">{{vc.i18n('国外','editReportInfoBackCity')}}</option>
                  </select>
                </div>
              </div>
              <div class="form-group row">
                <label class="col-sm-2 col-form-label"><span><vc:i18n name="城市名称" namespace="editReportInfoBackCity"></vc:i18n></span></label>
                <div class="col-sm-10">
                  <input v-model="editReportInfoBackCityInfo.sourceCityName" type="text" :placeholder="vc.i18n('必填，请填写城市名称','editReportInfoBackCity')"
                    class="form-control">
                </div>
              </div>
              <div class="form-group row">
                <label class="col-sm-2 col-form-label"><span><vc:i18n name="返回时间" namespace="editReportInfoBackCity"></vc:i18n></span></label>
                <div class="col-sm-10">
                  <input v-model="editReportInfoBackCityInfo.backTime" type="text" :placeholder="vc.i18n('必填，请填写返回时间','editReportInfoBackCity')"
                    class="form-control">
                </div>
              </div>
              <div class="form-group row">
                <label class="col-sm-2 col-form-label"><span><vc:i18n name="备注" namespace="editReportInfoBackCity"></vc:i18n></span></label>
                <div class="col-sm-10">
                  <input v-model="editReportInfoBackCityInfo.remark" type="text" :placeholder="vc.i18n('选填，请填写备注','editReportInfoBackCity')"
                    class="form-control">
                </div>
              </div>

              <div class="ibox-content">
                <button class="btn btn-primary float-right" type="button" v-on:click="editReportInfoBackCity()"><i
                    class="fa fa-check"></i>&nbsp;保存</button>
                <button type="button" class="btn btn-warning float-right" style="margin-right:20px;"
                  data-dismiss="modal"><span><vc:i18n name="取消" namespace="editReportInfoBackCity"></vc:i18n></span></button>
              </div>
            </div>
          </div>
        </div>
      </div>
    </div>
  </div>
</div>
